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Lee, Kim, Kim, Kim, Kim, Kim, Kwon, Rhew, Park, Park, Park, Park, Sung, Oh, Yoon, Lee, Cho, Cho, Chung, Jung, Hong, and Hyun: Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia
Original Article
Korean Journal of Urology

Korean Journal of Urology 2008; 49(9): 826-830.

Published online: 30 September 2008

DOI: https://doi.org/10.4111/kju.2008.49.9.826

Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia

Kyung Seop Lee, Min Eui Kim1, Se Joong Kim2, Han Kwon Kim3, Hong Sup Kim4, Chun Il Kim5, Tae Gyun Kwon6, Hyun Yul Rhew7, Kwangsung Park8, Dong Soo Park9, Jong Kwan Park10, Jae Shin Park11, Gyung Tak Sung12, Tae Hee Oh13, Sang Min Yoon14, Young Goo Lee15, In-Rae Cho16, Jin Seon Cho15, Jaeil Chung16, Hee Chang Jung17, Sung Hoo Hong18, Jae Seog Hyun19

Department of Urology, College of Medicine, Dongguk University, Gyongju, Korea.

1Department of Urology, College of Medicine, Soonchunhyang University College of Medicine, Asan, Korea.

2Department of Urology, College of Medicine, Ajou University School of Medicine, Suwon, Korea.

3Department of Urology, College of Medicine, Ulsan University College of Medicine, Ulsan, Korea.

4Department of Urology, College of Medicine, College of Medicine, Konkuk University, Seoul, Korea.

5Department of Urology, College of Medicine, Keimyung University School of Medicine, Korea.

6Department of Urology, College of Medicine, College of Medicine, Kyungpook National University, Daegu, Korea.

7Department of Urology, College of Medicine, Kosin University College of Medicine, Busan, Korea.

8Department of Urology, College of Medicine, Chonnam National University Medical School, Gwangju, Korea.

9Department of Urology, College of Medicine, Pochon CHA University College of Medicine, Pocheon, Korea.

10Department of Urology, College of Medicine, Chonbuk National University Medical School, Jeonju, Korea.

11Department of Urology, College of Medicine, Daegu Catholic University College of Medicine, Daegu, Korea.

12Department of Urology, College of Medicine, Dong-A University College of Medicine, Busan, Korea.

13Department of Urology, College of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.

14Department of Urology, College of Medicine, Inha University College of Medicine, Incheon, Korea.

15Department of Urology, College of Medicine, College of Medicine, Hallym University, Chungcheon, Korea.

16Department of Urology, College of Medicine, College of Medicine, Inje University, Busan, Korea.

17Department of Urology, College of Medicine, College of Medicine, Yeungnam University, Daegu, Korea.

18Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.

19Department of Urology, College of Medicine, School of Medicine, Gyeongsang National University, Jinju, Korea.

ksleemd@dongguk.ac.kr

Received 22 February 2008       Accepted 8 July 2008

Copyright © 2008 The Korean Urological Association

Abstract

Purpose

The aim of this study was to identify the clinical baseline factors that affect failure of medical treatment (and especially surgical treatment) for benign prostatic hyperplasia (BPH) in spite of long-term medication.

Materials and Methods

802 men who were over 50 years of age with BPH were enrolled for this study. Patients were allocated to a medication group and a surgical treatment group (after having at least a 12 month duration of medication). We compared the differences between the two groups for their initial International Prostate Symptom Score (IPSS), the uroflowmetry, the prostate volume, the postvoid residual urine and the serum prostate specific antigen (PSA).

Results

397 patients had surgical treatment following medication due to BPH progression (acute urinary retention, aggravating LUTS) and 405 patients were given maintenance medical treatment during follow-up. Statistically significant differences were found in the IPSS (23.3±6.6 vs. 12.7±8.4), the prostate volume (53.5±28.1ml vs. 38.3±12.6ml), the maximal flow rate (7.8±4.7ml/sec vs. 12.7±5.4ml/sec), the postvoid residual urine volume (92.7±144.4cc vs. 36.5±147.1cc), and the PSA (6.1±7.6ng/ml vs. 2.8±2.8ng/ml) between the surgical and medication groups. According to the area under the curve (AUC), the IPSS, prostate volume, maximal flow rate, postvoid residual urine volume and PSA are important in descending order. According to the receiver operating characteristic (ROC) curve-based prediction of the surgical intervention, the best cutoff value for the IPSS and prostate volume were 17 (area under ROC curve: 0.83) and 40ml (area under ROC curve: 0.68), respectively.

Conclusions

The results show that BPH patients with more severe IPSS (≥17) and a larger prostate volume (>40ml) have a higher risk of surgical intervention, and this suggests that the IPSS and prostate volume may be useful predictors at the initial visit for surgical intervention.

Keywords: Benign prostatic hyperplasia, Predictive factors, Symptoms, Prostate volume

Figures and Tables

Fig. 1
Receiver operation characteristic of each parameters. IPSS: International Prostate Symptom Score, PSA: prostate-specific antigen, PVR: postvoid residual urine, Qmax: maximum urinary flow rate, QoL: quality of life.
kju-49-826-g001
Table 1
Baseline clinical characteristics of each groups
kju-49-826-i001

IPSS: International Prostate Symptom Score, PVR: postvoid residual urine, PSA: prostate-specific antigen, PSAD: prostate-specific antigen density

Table 2
Hazard ratio for each parameters
kju-49-826-i002

CI: confidence interval, IPSS: International Prostate Symptom Score, PVR: postvoid residual urine, PSA: prostate-specific antigen

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ORCID iDs

Tae Gyun Kwon
https://orcid.org/http://orcid.org/0000-0002-4390-0952

Kwangsung Park
https://orcid.org/http://orcid.org/0000-0001-8827-162X

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